Category II Codes in Brief
Reporting of category II codes is optional, but has advantages. The AMA, which creates and maintains CPT®, states that category II codes “are intended to facilitate data collection about the quality of care rendered by coding certain services and test results that support nationally established performance measures and that have an evidence base as contributing to quality patient care.” For example, category II codes:
describe clinical components that may be typically included in evaluation and management services or other clinical services and, therefore, do not have a relative value associated with them. Category II codes may also describe results from clinical laboratory or radiology tests and other procedures, identified processes intended to address patient safety practices, or services reflecting compliance with state or federal law.
Additionally, per the California Quality Collaborative, the advantages of assigning cat. II codes include:
- Lessened administrative burden of chart review for many Healthcare Effectiveness Data and Information Set (HEDIS™) performance measures
- Enables organizations to monitor internal performance for key measures throughout the year, rather than once per year as measured by health plans and Pay for Performance.
- By identifying opportunities for improvement, interventions can be implemented to improve performance during the service year.
Category II codes are supplemental. You should never use them “in place of” category I or category III codes.
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